Provider Demographics
NPI:1588645006
Name:SIMPSON, CLETUS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLETUS
Middle Name:H
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:BUNN
Mailing Address - State:NC
Mailing Address - Zip Code:27508
Mailing Address - Country:US
Mailing Address - Phone:919-729-1103
Mailing Address - Fax:919-729-1105
Practice Address - Street 1:565 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUNN
Practice Address - State:NC
Practice Address - Zip Code:27508
Practice Address - Country:US
Practice Address - Phone:919-729-1103
Practice Address - Fax:919-729-1105
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80311223G0001X, 1223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC560794933OtherTAX ID #
NC800285780Medicaid